What its Like to Be on Medicare Now

Reprinted from the NYTimes July 31 2019. By Abbey Goodnough

Medicare for All? For More? Here’s How Medicare Works

As Democrats embrace the idea of expanding the federal health insurance program, we looked at what it covers and costs. It’s far from “free.” Medicare, the federal health insurance program for people who are 65 or older, has become something of a panacea in the Democratic presidential race.

Some candidates, including Senators Bernie Sanders and Elizabeth Warren, want to give it to everyone and even expand its benefits. Others, like former Representative Beto O’Rourke, want to give it automatically to people who don’t have other health insurance. Many, including former Vice President Joseph R. Biden, want to give people the right to buy into a Medicare-like public health insurance program. Whatever their positions, Medicare is what most of the candidates are holding up as a model for universal coverage, a goal they all embrace.

Medicare is popular among its 60 million beneficiaries, but the program also has limitations, and it is certainly not “free.” Co-payments can be high for some people, especially for long-term hospitalization and some medications. Some Democratic proposals, including those from Mr. Sanders and Ms. Warren, would changethat by eliminating premiums and deductibles, and pay for the program instead with higher taxes.As expansion of Medicare becomes a campaign season rallying cry, we took a look at what it’s like to be on Medicare now.

Here are some answers to basic questions.

What exactly does Medicare cover? Are the benefits good?

The benefits are comprehensive, though not exhaustive. Medicare divides benefits into categories. One, Part A, covers inpatient care at hospitals and — with some limits — skilled nursing facilities, where people often go to recover from an injury or illness. It also covers hospice care and, in some circumstances, home health care. Another category, Part B, covers doctor appointments, outpatient procedures and tests, some mental health services, as well as wheelchairs, walkers and other equipment. Prescription drugs are covered under Part D. Part C is a privately run managed care option called Medicare Advantage.

What doesn’t Medicare cover?

Medicare does not cover glasses, basic eye exams, hearing aids and most dental care — frustrating omissions for many beneficiaries, who are at an age when they are more likely to need these services. It also won’t pay for care received outside the United States.

But by far the most expensive thing Medicare doesn’t pay for is long-term care in nursing homes, assisted living facilities or at home. Some people buy long-term care insurance, or spend down their assets to qualify for Medicaid, which does cover nursing home care. A private room in a nursing home cost an average of $100,375 last year, according to Genworth, a financial company.

Part A typically has no monthly premiums (like Social Security, it’s financed by payroll taxes all workers pay), but it has a deductible of $1,364 per “episode of illness,” plus a fixed amount — as high as $682 a day — if you spend more than 60 days in the hospital.

For Part B — doctor’s visits and outpatient care — premiums are based on income. The standard premium this year is $135.50 a month, but financial help is available for people with low incomes who don’t qualify for Medicaid, the government health program for the poor, which covers just about everything.

Richer Medicare beneficiaries — individuals with annual incomes over $500,000 — pay $460.50 a month. Premiums are typically deducted from people’s Social Security checks. Part B also has a deductible of $185 a year, and co-payments of 20 percent after you reach your deductible.

Many people buy supplemental “Medigap” insurance to cover Medicare’s out-of-pocket costs.

Unlike Affordable Care Act plans, Medicare has no cap on out-of-pocket spending, so the cost can climb quite high for sick people. An analysis by the nonpartisan Kaiser Family Foundation found that Medicare enrollees in fair or poor health spent an average of $6,128 in 2013, or 47 percent of average Social Security income.

Prescription drug costs can also be high in Medicare, and they represent one of the most complex, confusing parts of the program. Medicare Part D plans are run by private insurers, and the premiums cost $40 a month on average this year, according to Kaiser. There are also annual deductibles before coverage kicks in — they are capped at $415 this year — plus co-payments and coinsurance. But if your income is low enough, you may qualify for extra help paying for drugs, and in some cases, owe no premiums or out-of-pocket costs.

Then, there is the dreaded “doughnut hole” — a gap in which the Medicare drug plans don’t pay for patients’ medications after they have spent a certain amount — this year, $3,820. At that point, enrollees have to pay 25 percent of the cost of brand-name drugs, and 37 percent of the cost of generic drugs, until their total out-of-pocket spending has reached $5,100. Once they hit that, they qualify for “catastrophic coverage,” and only pay a small co-payment for covered drugs for the rest of the year.

Kaiser recently found that one million Medicare beneficiaries had out-of-pocket spending above the catastrophic threshold in 2017, averaging $3,214.

Medicare Advantage is an increasingly popular alternative to traditional Medicare. Advantage plans are offered by private insurers that have contracts with Medicare. These plans have all the same benefits as traditional Medicare, and often more, such as dental care or health club memberships. Co-pays and deductibles vary depending on the plan. Unlike traditional Medicare, all Medicare Advantage plans have limits — $6,700 this year in most cases — on out-of-pocket spending.

Medicare pays Advantage plans a fixed monthly sum for each beneficiary, while in traditional Medicare, providers are paid for each service based on an annual fee schedule. As a result, Advantage plans tend to use tools like pre-authorization requirements and strict provider networks to control costs.

Those restrictions can be a turnoff to people with a lot of medical needs. Some data suggests people with Medicare Advantage tend to be healthier but less wealthy than those with traditional Medicare. One thing is certain: the private plans are growing in popularity. About one-third of Medicare recipients, or 22 million people, now have them, up from six million in 2005.

This depends largely on whether they have traditional Medicare or a Medicare Advantage plan. Traditional Medicare allows beneficiaries to seek care from any doctor or hospital in the United States that accepts it, and does not require referrals to specialists or prior authorization for services.

But Medicare Advantage plans typically have strict networks of medical providers that beneficiaries have to use unless they are willing to pay more. Some Advantage plans may cover care outside the network, according to the Center for Medicare Advocacy, but the out-of-pocket costs are generally higher than for in-network care. Advantage plans do cover emergency care outside their network — if you are traveling domestically, for example — but nothing else.

No, but most do. According to the federal Centers for Medicare and Medicaid, 2,752 doctors and other providers opted out of Medicare in 2018 — a minute number considering there are more than one million practicing doctors alone. Psychiatrists are the biggest category of doctors who opt out, according to Kaiser.

A small share of doctors who accept Medicare are called “nonparticipating providers,” meaning they can choose to charge Medicare patients higher fees, up to a certain limit. The patients are responsible for paying the full amount beyond what Medicare pays — a practice called balance billing.

It is even more rare for a hospital not to accept Medicare, although some private psychiatric or other specialty hospitals that cater to the wealthy may not.

Yes, although few people take this step, at least according to a report last year by the inspector general at the Department of Health and Human Services. The report found that beneficiaries and providers appealed more than 863,000 denials from 2014 through 2016 — only about 1 percent of the total number of denials during that period. But their success rate was high: About 70 percent of the appeals were fully successful at the first level (there are five possible levels to keep appealing to), according to the report. Most were from providers regarding payments that had been denied, not patients regarding services that had been denied.

Reed Abelson contributed reporting.

7 of Your Most Burning Questions on Social Security (With Answers)

 Reprinted from the NY Times. Mark Miller 8/2/2019.

People have lots of questions about Social Security: Will it still be around when I retire? How much will I get? How does the spousal benefit work?

That’s not surprising.

No government program is more important to so many Americans. This year, Social Security is expected to pay $1.1 trillion to 69 million recipients of retirement and disability benefits and Supplemental Security Income. Nearly all Americans pay into the program and can expect to receive a benefit at some point in their lives. And it is the largest retirement income source for a majority of older households.

The New York Times recently invited readers to submit their questions about Social Security. Today, we’re responding to some of the most frequent ones.

Is Social Security financially secure? Should people in their 60s who can afford to wait to claim benefits wait until they can get the highest monthly benefit, or should they consider signing up now because the program may not be there in 20 years?

In the years ahead, Social Security does face a financial shortfallthat requires action by Congress. The combined trust funds for Social Security’s retirement and disability programs are on course to be depleted in 2035; without changes, funding from payroll tax receipts will be sufficient to pay only 80 percent of currently scheduled benefits.

That would mean immediate, across-the-board benefit cuts, but the pain would be felt most acutely by today’s younger workers and low-income retirees.

“If policymakers don’t address Social Security’s finance gap by 2035, all Gen Xers and millennials would experience the cuts throughout retirement,” notes Richard W. Johnson, director of the program on retirement policy at the Urban Institute. “An additional one-third of retirees could end up in poverty.”

The shortfall stems primarily from the retirement of baby boomers combined with the slow growth of the labor force, which reduces the ratio of workers paying into the system and beneficiaries. Rising life expectancy also plays a role; so does rising inequality in worker earnings.

When Congress last adjusted the cap on wages subject to the payroll tax in 1977, the intent of lawmakers was to cover 90 percent of all wages. But wages above the cap have grown more quickly than the average wage, so the cap (set this year at $132,900) now covers only 83 percent of wages, reducing taxes flowing into the system.

“Given the strong public support for the program, it is inconceivable that Congress won’t step in sometime before 2035 and put things on an even keel,” he says. “It’s a source of concern, but not something to lose sleep over.”

Congress could put Social Security back into financial balance with new tax revenues, benefit cuts or a combination of both. The Democratic-controlled House is advancing a plan that would putSocial Security back into balance over the next 75 years by increasing payroll tax rates by 0.1 percentage point annually through 2043, reaching 14.8 percent for that year and later. The bill also would apply payroll taxes to earnings over $400,000, starting in 2020. The bill would expand benefits modestly.

The legislation, sponsored by Representative John B. Larson, Democrat of Connecticut and chairman of the Ways and Means Social Security Subcommittee, has 211 co-sponsors in the House.

Could you provide a full explanation of “spousal benefits” for living spouses, and for widows, widowers and divorced people?

The spousal benefit is available to couples who have been married at least one year. It allows one partner to claim a benefit as high as 50 percent of the benefit at full retirement age of his or her spouse — so long as that spouse has already claimed benefits. That requirement often trips up people hoping to generate some income while the higher-earning spouse puts off claiming benefits to earn delayed retirement credits.

“It’s one of the most misunderstood things that we see,” says Elaine Floyd, director of retirement and life planning for Horsesmouth, a firm that trains financial advisers.

If you are entitled to a spousal benefit when you file, in most cases you must file for both your own and your spousal benefit simultaneously. You’ll be paid your own benefit first; a spousal benefit amount will be added if your own benefit is less than half of your spouse’s total. Filing means that you will no longer accrue delayed retirement credits.

People born before Jan. 2, 1954, can still file for a “restricted claim” of only their spousal benefit. They were grandfathered into rules in place before passage of the Budget Act of 2015. This provision allows them to receive a spousal benefit while building delayed retirement credits on their own account, until age 70.

In all cases, widows or widowers can receive a survivor benefit when a spouse dies, providing they were married at least nine months at the time of death. In most cases, the survivor benefit is equal to 100 percent of the deceased spouse’s benefit.

Many divorced people are surprised to learn that they can file for a spousal benefit on the record of an ex-spouse. To qualify, you must be single and have been previously married to your ex at least 10 years. You also cannot be receiving a benefit greater than your divorced spouse’s benefit. If the ex is 62 or older and the divorce occurred over two years earlier, the ex does not need to have filed for his or her benefit.

Eligibility for an ex’s benefit is lost if you remarry, and you can’t file for benefits on your new spouse’s earnings record until you’ve been married to that person at least one year.

If your ex-spouse is deceased, you may be able to claim a divorced-spouse survivor benefit. The rules are basically the same except that you can be remarried as long as you remarried after age 60.

Spousal benefits were made available to same-sex married couples after the landmark 2013 Supreme Court decision striking down key provisions of the Defense of Marriage Act.

Do Social Security benefits last your lifetime?

Yes — benefits are paid as a monthly annuity, and they are adjusted for inflation each year.

“Not only is it the cheapest annuity that you can buy, but it is very difficult to find an annuity of any kind that is adjusted for inflation,” says Dirk Cotton, a retirement researcher. “That makes Social Security extremely valuable.”

Why do most articles about Social Security push the idea of waiting until you’re 70 to claim and don’t mention the “break even” calculation that would help you decide whether to claim earlier?

The break-even age is a very common method for deciding when to claim. This is the age in the future when, if you started claims at different ages, your accumulated benefits would be equal. Starting benefits early works to your advantage if you don’t live to the break-even age; you also come out ahead by delaying benefits and then living beyond the break-even point. The losing outcome is delaying benefits and dying before reaching the break-even age.

Here’s how claiming ages affect benefit amounts. Social Security starts by taking into account your 35 years of highest wages, and translates this into something called the primary insurance amount (P.I.A.). If you wait until the current full retirement age of 66, you will receive 100 percent of P.I.A. If you start at 62 (the earliest opportunity), you will receive a reduced benefit for the rest of your life — 25 percent lower. By waiting past full retirement age, you would get the delayed retirement credit, which is 8 percent for each 12-month period that you delay. The credits are available until age 70.

Andy Landis, a Social Security expert and the author of “Social Security: The Inside Story,” refers to break-even as the “money ahead” date.

For a claimant with a full retirement age of 66 who files at 62, Mr. Landis calculates that her money-ahead age is 78 — that is, she will be ahead in lifetime benefits until age 78; at that point, a person with the same P.I.A. who waits until full retirement age will catch up with her. After that, the later filer is ahead for the rest of her life.

If the same woman files at 66, her money-ahead age is 82.5 — after that age, someone who waits until 70 to file is ahead permanently. (Mr. Landis’s examples assume inflation-adjusted dollars and exclude any taxation of benefits.)

But many experts argue that break-even is not the best way to decide when to claim, because of Social Security’s value as an inflation-adjusted guaranteed source of lifetime income.

“None of us who are healthy have any idea when we’ll die,” Mr. Cotton says. “So it’s not a good way to make the decision, unless you have a really good reason to think you won’t live at least 18 years.”

You can run your own numbers using the tables and calculator on the Social Security website.

I am 68, and my Social Security benefit amount is lower than my husband’s because I stayed out of the work force for five years to raise my children — even though he worked fewer years and earned less over all than I did. Has there been any progress in raising benefit amounts for people in my situation?

The responsibility of caring for children, elderly parents or other relatives remains a key reason that women tend to work fewer years than men. That reduces their income from Social Security, pensions and savings.

Caregiver credits are applied by the retirement programs of many industrialized nations, including Britain, Sweden and Germany. In the United States, lawmakers and policy experts have proposed a variety of remedies. One would allow caregivers to exclude more years from the P.I.A. formula; allowing caregivers to exclude five years would increase their benefits. Other plans would provide wage credits to caregivers.

“It would be an imputed income amount for the years when you were providing caregiving,” says Nancy Altman, president of Social Security Works, an advocacy group, and a member of the Social Security Advisory Board, an independent bipartisan government agency. “This definitely is an issue that has come to the attention of policymakers, and doing something about it has broad support. The question is when we will see some action on it.”

How much of my Social Security income will be taxed?

For lower-income retirees, Social Security usually is tax free, while higher-income seniors pay taxes on a sliding scale. No more than 85 percent of your benefit is taxable.

To determine if your benefit is taxable, add up your gross income, nontaxable interest income and half of your Social Security benefit. If that number exceeds $25,000 (for individuals) or $32,000 (joint filers), some portion of your benefit is taxable. For details, see the instructions for completing lines 5(a) and 5(b) of Form 1040 in the Internal Revenue Service’s guide.

I own my own business. Is it possible for me to “pay into” Social Security?

Assuming you are paying self-employment taxes, you already are contributing. The self-employment tax, paid in lieu of the payroll tax that employers split with employees, is 15.3 percent, with 12.4 percent going to Social Security and 2.9 percent to Medicare.

Self-employed people pay double the rate that they would as employees, but can deduct half the cost from income taxes when they calculate their adjusted gross income.

Business owners who are incorporated pay Social Security taxes as employees. More information is available from the I.R.S.

Correction: 

An earlier version of this article referred imprecisely to the way a spousal Social Security benefit is calculated. The benefit can be as high as 50 percent of a spouse’s benefit at full retirement age, not 50 percent of the spouse’s benefit.

 

Help them win a grant, help your patients stay safe!

Fellow occupational therapists! Barbara Hellman, MOT, OTR/L and her daughter* invented a product that makes car seat buckles easy (for grandparents, parents with hand weakness etc.)  They are now a TOP 8 finalist for a $5K Grant and need your vote to help them win.
The contest ends on this Tuesday July 16th, so please take a moment to support a fellow therapist and vote for UnbuckleMe.

Vote here: https://themamaladder.com/grant
Barbara’s daughter and business partner Rebecca Davison* is the Mom Entrepreneur listed (scroll down to find her name & UnbuckleMe).

Thank you so much!  The support from the therapy community is greatly appreciated, and it is perfectly okay to vote from more than one device until July 16th.

UnbuckleMe is the award-winning solution for parents or grandparents who struggle to unbuckle kids’ car seat buckles (commonly due to arthritis, carpal tunnel syndrome, de Quervain’s or other hand/wrist conditions).
Barbara Hellman, MOT, OTR/L and her daughter Becca are eager to share UnbuckleMe with people who need it. Use promo code OTLOVE to save 15% off purchases on the website.

They also work with private clinics and practitioners across the country and sell wholesale with a minimum 6 piece order.

Here’s a great video of the product in action: https://youtu.be/5yXB76HvVmoNeed some inspiration? Read this blog and get inspired on  how they brought this product to market!Feel free to reach out to Barbara directly at barb@unbuckleme.com to learn more.

 UnbuckleMe.com
Connect with us on FacebookTwitter and Instagram!

 

UnitedHealthcare Announces New Pilot Program to Increase Access to Physical Therapist Services as Result of Collaboration With APTA

This week, UnitedHealthcare (UHC) announced a pilot program in 5 states that will waive the cost of copays and deductibles for 3 physical therapy sessions for patients with low back pain (LBP) living in Connecticut, Florida, Georgia, North Carolina, and New York. The pilot, which could affect as many as 1 million enrollees, goes into effect July 1, 2019. Other states will join the program in 2020 and 2021.

Specifically, the pilot will be available to UHC enrollees with new onset of LBP when receiving care from an outpatient in-network provider. This benefit change will not extend the enrollee’s physical therapy or chiropractic benefit maximum, and will apply only to services related to treating back pain. Enrollees must have physical therapy or chiropractic benefits remaining in order to use this benefit.

UHC will send emails about the benefit change on a quarterly basis to enrollees in the 5 states as they gain access to the benefit. Information also will be included on myuhc.com in the enrollee’s benefit information under Rehabilitation Services – Outpatient Therapy and Chiropractic (Manipulative) Treatment.

This pilot follows a multiyear collaboration between APTA, OptumLabs, and UHC that included publication of a study in the American Journal of Managed Care (subscription required). This study affirms that higher copays and payer restrictions on provider access may steer patients away from more conservative treatments for LBP, including physical therapy and chiropractic services. “Innovative modifications to insurance benefits,” authors write, “offer an opportunity for increased alignment with clinical practice guidelines and greater value.”

“This type of collaboration between a professional association and a private insurer is key to advancing the essential role of the physical therapy profession in improving outcomes for patients,” says Carmen Elliott, MS, APTA’s vice president of payment and practice management. “APTA continues to advocate for benefit design that is validated by data and meets the needs of patients, providers, and payers.”  For additional info 

Here’s my two cents... Having been in the industry for long enough to to remember the days when providers worried that insurers would not honor negotiated reimbursement rates, while insurers were concerned  that providers would find loopholes to augment the claims they submitted,  I am always happy when I read of  insurer-provider alliances. I do  think this program is a step in the right direction. On the other hand, while the APTA was talking with UHC, I wish they would have discussed how this insurance company has devalued the profession, and has adopted a LOW flat fee methodology for its in network providers that does not factor in the amount of time a therapist spends with a patient. UHC also has a history of audits using a “Recovery Services” team who aggressively try to classify therapy services either as medically unnecessary, or retroactively deny payment, and often demand  refunds because documentations submitted in audits ” did not support” payment or meet their standards. For certain practices, especially those OON, I have never seen a more aggressive attempt to classify services that were rendered in the good faith that they would be paid for as “overpayments” with refunds demanded or taken from future payments. These are not simply “first world problems’ of physical therapists; they strike at the core of why more and more practices opt out rather than in with carriers like United Health Care. Addressing these core issues could help all patients, not just those with LBP and really help increase a patient’s access to physical therapy.

 

Did Your Doctor Disappear Without a Word? A Noncompete Clause Could Be the Reason

Reprinted from the NY Times March 15th 2019 –

When Don Cue developed a bladder infection last fall, he called his longtime urologist’s office for a urine culture and antibiotics. It was a familiar routine for the two-time prostate cancer survivor; infections were not uncommon since he began using a catheter that connects to his bladder through an incision in his abdomen.

When Mr. Cue called this time, a receptionist told him that his physician, Dr. Mark Kellerman, no longer worked at the Iowa Clinic in Des Moines, a large multi-specialty group. She refused to divulge where he had gone.

“As a patient, ‘scared’ is too strong a word, but my feeling is, ‘What do I do now?’” said Mr. Cue, 58.

Flummoxed, he solved his immediate problem by taking leftover antibiotics he had in his medicine cabinet.

It was only later that he learned his doctor had been fired by the Iowa Clinic and planned to start a urology practice with clinic colleagues. And, under the terms of their contract with their former employer, the doctors were banned for a year from practicing within 35 miles of the clinic, and from recruiting former patients to follow them.

Contracts with so-called restrictive covenants are now common in medicine, although some states limit their use. Noncompete clauses — common in many commercial sectors — aim to stop physicians and other health care professionals from taking patients with them if they move to a competing practice nearby or start their own. But what may be good for business can be bad for patient care — and certainly disquieting for those whose doctors seem to simply disappear.

One survey of nearly 2,000 primary care physicians in five states found that roughly 45 percent were bound by such clauses.

Continuity of care is important, doctors say, especially for patients with ongoing medical issues. Cutting off access to a doctor is different from disrupting someone’s relationship with a favorite hairstylist or money manager, they say.

“When doctors want to move from one practice to another, if they’ve got good therapeutic relationships with their patients, you’d think that public policy would want them to continue to treat these patients that trust them,” said Judy Conti, government affairs director at the National Employment Law Project.

 

Help save the Early Childhood Direction Centers! They need our help RIGHT NOW

  NY State has terminated the contract with the Early Childhood Direction Centers, and all of them will close as of June 30, 2019.
As many of you know ECDC  as been an amazing resource for families and professionals helping to navigate the systems of EI, transitioning to CPSE etc. for the past 30 years.
It has been said that the NYS Board of Regents is very concerned about the ECDC closure and the lack of transparency in the process. The Regents are meeting this coming Monday, January 14th which means there’s a very short window to make our feelings known! We need to tell them what the ECDC has done for us and what the lack of that support will mean for families of young children.
Here is the contact info to let your concerns be known:
Betty A. Rosa
Chancellor
12th Judicial District
Regents Office, State Education Building, 89 Washington Avenue, Albany, N.Y. 12234
(518) 474-5889
Regent.Rosa@nysed.gov
T. Andrew Brown
Vice Chancellor
7th Judicial District
925 Crossroads Building, Two State Street, Rochester, NY 14614
(585) 454-3667
Regent.Brown@nysed.gov

Commissioner of Education and
President of the University of the State of New York
MaryEllen Elia
(518) 474-5844
Commissioner@nysed.gov

P-12 Instructional Support
Deputy Commissioner
Angelica Infante-Green
(518) 474-5915

Christopher Soriano
Assistant Commissioner Special Education
Email: speced@nysed.gov

PT and OT  Receives Significant Payment Increase from NYS Worker Compensation Board for 2019

On December 26th, the New York State Workers’ Compensation Board adopted regulations which substantially increase payment for PT and OT therapy services provided to injured workers effective April 1, 2019.

The conversion factor for PT and OT services increased from 21 to 30 percent across the 4 regions of the state. The average conversion factor increase across all 4 regions was 25.4%

Initial evaluations are capped at 18 RVUs, revaluations are capped at 15 RVUs and follow up visits are capped at 12 RVUs, all of which allow for a greater intensity/duration of medically necessary treatment to be provided per session.

The changes in the fee schedule will take effect April 1, 2019.

There is NO  hard cap of 12 visits/180 days.
I will post additional information as I find it out.

Let Kids Play. Doctor’s Orders.

Reprinted from the NYTimes  August 20 2018.  By Dr. Perri Klass, MD
Doctors should prescribe playtime for young children, the American Academy of Pediatrics says.

The most famous painting of children at play is “Children’s Games,” the 1560 work by Pieter Bruegel the Elder of a town square in which children from toddlers to adolescents (scholars have counted 246) are playing a range of timeless games. There are dolls and marbles and tiddlywinks, ball games and climbing games and riding games (scholars have counted 90 or so). The children are the only ones in town, and their activities offer a kind of taxonomy of play.

But some worry that our current culture is less friendly to play, and that children may not be getting the chance to explore all its possibilities. To try to address that, the American Academy of Pediatrics released a policy statement on Monday titled “The Power of Play: A Pediatric Role in Enhancing Development in Young Children.”

The statement characterizes play as intrinsically motivated, involving active engagement and resulting in “joyful discovery.” It summarizes extensive developmental and neurological research on play, and tries to tease out some of the specific developmental discoveries in peek-a-boo (repetitive games provide “the joy of being able to predict what is going to happen”) and Simon Says (builds impulse control and executive function). It also says that doctors should encourage playful learning for parents and infants by writing a “prescription for play” at every well-child visit in the first two years of life.

It’s a values statement because many who study play feel that it is under siege, even as new research emphasizes its importance in children’s development.

We’re in a climate where parents are feeling like they need to schedule every minute of structured time, and 30 percent of kindergartens offer no recess,” said Dr. Michael Yogman, chairman of the A.A.P. committee on psychosocial aspects of child family health and the lead author of the statement. To some, he said, “play is seen as irrelevant and old-fashioned.”

Dr. Benard Dreyer, the director of developmental and behavioral pediatrics at New York University School of Medicine and a past president of the American Academy of Pediatrics, said, “The old saying is, play is the work of children. Play is the way they learn and the way they develop. It’s important to understand how all of us, and especially parents, can encourage play.” “Kids develop 21st-century skills in play,” said Dr. Yogman, who is chief of the division of ambulatory pediatrics at Mount Auburn Hospital in Cambridge, Mass. These include social and emotional skills and executive function, “skills that are crucial for adults in the new economy, that help them collaborate and innovate.”

A fundamental job in pediatric primary care is to strengthen the parent-child relationship, he said, and play is important in that area as well. Even with a very young child, he said: “When a 3-month-old smiles and a parent smiles back, those kinds of turn-taking activities are not only far from trivial,” but are actually important for developing language and social-emotional skills, such as taking turns.

The stable relationships with parents and other caregivers that are built through these interactions are also important for helping children navigate stress and trauma and preventing what we have come to call “toxic stress” from damaging the child’s development.

 

California PTs OTs and STs – New Rules on Independent Contractors in Effect

California PT OT and STs –  the California Supreme Court issued a decision April 30th which results in  new legal standard for determining whether a worker is an independent contractor or an employee. This is a major development in California employment law that will cause many workers now classified as independent contractors to be considered employees in the eyes of the state.

Under the Court’s new “ABC” test, a worker is presumptively considered an employee under the California Wage Orders unless the employer can establish all of the following three elements:

  •  The worker is free from the direction and control of the person who hires him/her in connection with the performance of the work, both under the contract for the work and in fact;
  •  The worker performs work that is outside the usual course of the hiring entity’s business
  • The worker is customarily engaged in an independently established trade, occupation, or business of the same nature as the work performed for the hiring entity.

Now is the time for practice owners to look carefully at the nature of your relationship with therapists who work for you – misclassification falls on your shoulders, and I can tell you first hand that Labor and IRS Department audits are not fun, and misclassifications can  be very costly in terms of interest and penalties.

 

NYTPA is now an Approved ABA Provider in the Greater NY Area

Families living within 5 Boroughs of New York City, Long Island and Westchester can benefit from our team of Licensed Behavior Analysts (BCBA) and Behavior Therapists. We are ready to structure a program to address behavior goals, communication training and life skills essential for independence. Parents benefit from guidance and experience in the form of parent training and participation in the therapy. This program comes to you from an agency with 30 years of experience providing therapeutic and educational services across multiple modalities.

We make the process simple:
1.  Speak with our team and provide some basic information about your child.
2.  Once we verify insurance benefits, parents will need to provide proof of diagnosis and prescription for services.
3.  We will obtain authorization from the insurance carrier to assess, develop treatment plan and begin treatment.

We accept most major insurance plans including GHI, UHC, Fidelis Care, NYSHIP,  and Oxford. Our team is ready to help verify your benefits, eligibility and check whether you are covered. For some insurance carriers, the service can be provided at no cost.

If you’re a provider and know of a family or families who can benefit from this service, please feel free to pass along this information.  Please call our main office and inquire about ABA Therapy.
(718)264-1640
-Or-
Email:
ABATherapy@nytps.org
www.nytps.com